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The Treatment of Autism

Autism is becoming increasingly common for the same reason that other human diseases such as neuro-degenerative conditions (Alzheimer's disease and Motor neurone disease), chronic fatigue syndrome, organ failures and so on are becoming increasingly common. It is a result of life in the 20 and 21st century with changing diets, declining nutritional status, increasing toxic stress and increasing viral load because of world populations and travel. Therefore the overall approach to management is exactly the same for all these problems, although the emphasis for different problems will be slightly different.

My understanding of the treatment of autism specifically has been advanced by a book "The Puzzle of Autism: Putting It All Together" by Dr Amy Yasko and Dr Garry Gordon. These two doctors have developed a protocol of treatment, which has benefited all the children they have treated to a greater or lesser extent. Much of what they do I already use in the treatment of autism, but there are other areas well worth exploring. I do recommend that you get the book, but it strikes me that the issues which have to be tackled are as follows:

1. Allergies and Excitotoxins
Almost all autistic children are improved by a diet which avoids grains, dairy, yeast, sugar, additives, colourings, flavourings and artificial foods. This could be explained by excitotoxins such as glutamate in the diet, which has a generally excitatory effect. Actually wheat gluten is 43% glutamate, milk protein is 23% glutamate and there are also high levels in MSG, Aspartame, Hydrolysed vegetable protein, yeast and so on. So doing this diet is the first port of call. There may also be allergies to foods which can cause associated symptoms in the gut and brain. See Stoneage Diet - this is a diet we should all follow.

2. Toxic Metals
There is overwhelming evidence that heavy metals are implicated in autism (as indeed in many neurological diseases such as Parkinson's disease, Alzheimer's disease and Motor Neurone disease). Our environmental levels of toxic metals have increase dramatically since stoneage times as a result of mercury and aluminium being used in childhood immunisations, mercury in Rhesus antibody injections, aluminium is now used as an adjuvant in immunisations instead of mercury, lead poisoning is an extremely common problem. We also see mercury in dental amalgam fillings and in seafoods. We know that autistic children are less efficient at excreting heavy metals - hair analysis often shows levels of these lower than in normal children. This is because autistics dump these metals into their brains instead of excreting them into hair and nails.

3. Poor Ability to Detoxify (This is an extension of the above).
Rosemary Waring has clearly demonstrated defects in sulphur metabolism in autistics and sulphur is an essential part of detoxing xenobiotics - not just heavy metals, but also endogenous toxins such as neuro-transmitters. Improving ability to detoxify by supplementing with vitamins, minerals, essential fatty acids and amino acids such as glutathione is an essential part of treatment. See The Methylation Cycle

4. Chronic Viral Infection
Viruses do not have the molecular machinery to replicate themselves - they have to use the molecular machinery of the host cells to reproduce themselves. In order to achieve this they have to get round the immune system and they do this by causing immune suppression. One possible mechanism of this is that the viruses may encourage the body to accumulate heavy metals, thereby knocking off its immune system. Clever eh!

Three viruses (all single RNA strands) known to cause brain damage on their own are measles, mumps and rubella. This may partly explain why MMR seems to be particularly good at switching on autism because these viruses already have an affinity for the brain. Given in combination we know that they are more pernicious than in isolation and indeed work done by Andrew Wakefield has demonstrated how measles virus when given as MMR colonises the gut and causes swelling of the lymphoid system in the gut (Peyer's patches). So as a rule, live vaccinations in combination should be avoided. See my immunisation handout.

5. Abnormal Gut Flora
Excessive use of antibiotics, high carbohydrate diets, vaccinations and so on can all upset the gut flora and lead to a pro-inflammatory tendency, poor detox ability and a tendency to acquire infections, especially entero-viruses easily. If you count up all the cells in the body including gut bugs, then you and I are 95% bugs! They have their own genes which code for many substances essential for normal health. Indeed there are many more bacteria genes than human genes and play an important role in normal detoxification and immune function. The gut flora can be treated by using high dose probiotics. The one I currently favour is Kefir - see probiotics handout.

6. Poor Methylation
Neuro-transmitters, especially excitotoxin neuro-transmitters are metabolised by methylation, so if this is malfunctioning then excitotoxins as above will have a more malign effect. The enzymes involved in methylation are multiple and several pathways are involved, but one needs to start off by looking at B12 and folic acid, the latter may be best given as Folinic acid. Dr Yasko investigates this by doing FIGLU (folate) and urinary MMA (B12) and also SNPs test (pronounced snips, single nucleotide polymorphisms). See The Methylation Cycle

7. Thyroid
Borderline hypothyroidism is extremely common and it is essential to measure a Free T4, Free T3 and TSH. See Hypothyroidism - how to treat it

8. A Tendency to Inflammation Inflammation will tend to flare all of the above and anything that can be used to reduce an inflammatory tendency will be helpful. This may explain why anti-inflammatory herbal preparations are helpful with the most popular being glucosamine (used to reduce diarrhoea in autistics), Curcumin, Boswellia, Devil's Claw, etc.

9. Poor Mitochondrial Function
The symptom of this may be poor levels of physical and mental energy. Mitochondrial support for some patients Dr Yasko finds very helpful and supplements including D-ribose, Co-enzyme Q10, Acetyl L-carnitine and NAD may be helpful. See CFS section and Mitochondrial information.

The practical details of putting all this together are in Dr Yasko's book, but a broad outline is:

Progress with the above can be monitored firstly by seeing clinically how the patient gets better with respect to behaviour, development, sleep and gut function.

Useful tests

Urine test - to look at toxic metals - this can be done following a zinc supplement (20mgs) to see which potentially toxic metals are eliminated.Sweat test for trace mineral levels (almost invariably one sees low levels of magnesium, zinc, manganese).Thyroid test - TSH, free T4 and free T3 - can be done on saliva sample if necessaryComprehensive digestive stool analysis - looking for efficiency of digestion, gut dysbiosis and parasites.Urinary Organic Acids - these look at many markers of biochemistry such as the methylation cycle (MMA and FIGLU), krebs citric acid cycle, ability to detox, gut function and neurotransmitter levels. A very useful screening tests.
Mitochondrial function - there is increasing evidence that autism may result from poor mitochondrial function in brain cells.